新型冠状病毒肺炎合并静脉血栓栓塞症的临床特征及防治

Coronavirus disease 2019 combined with venous thromboembolism:Clinical features and prevention

目的:研究新型冠状病毒肺炎(COVID-19)合并静脉血栓栓塞症(VTE)的临床特征及防治方法,为疾病的预防、诊断及治疗提供科学依据。方法:回顾性分析2020年1月30日—3月19日武汉大学人民医院东院COVID-19合并VTE患者的临床资料,分析患者的一般情况、主要症状体征、既往史、实验室检查、彩超、CT血管造影、治疗方法、并发症、预后等结果的差异。结果:1 448例COVID-19患者中17例(1.17%)VTE阳性,60~69岁患者多发,临床分型以危重型(64.7%)及重型(35.7%)为主;主要的临床症状为下肢肿胀(70.6%)、疼痛(35.7%);58.8%患者有与VTE相关的既往史;VTE多为周围型(58.8%),累及双侧肢体(41.2%);末次查血中性粒细胞占比、D-二聚体、纤维蛋白降解产物水平低于入院时的水平,而淋巴细胞总数及占比高于入院时的水平;64.7%患者有静脉置管操作,58.8%的患者进行气管插管或切开;2例患者行体外膜肺氧合(ECMO);全部患者均药物治疗,患者的出血风险高达53%,心脑血管意外的风险极高;患者预后欠佳,死亡率高达23.5%,治愈率(17.6%),好转率(47.1%),仍有2位患者(11.8%)病情危重。结论:COVID-19合并VTE好发于老年危重型及重型患者,男性居多,患者症状不典型,应尽早进行VTE风险评估及积极的防治,合并出血及心脑血管意外风险极大,但积极治疗后大部分仍可好转出院。

Objective:To analyze the clinical characteristics and control methods of coronavirus disease2019(COVID-19) complicated with venous thromboembolism(VTE), and to provide scientific basis for disease prevention, diagnosis and treatment.Methods:We retrospectively studied the cases of COVID-19 complicated with VTE in Renmin Hospital of Wuhan University from January 30, 2020 to March 19, 2020, and their clinical features, results of exmaninations, treatment methods, complications, and prognosis were reviewed.Results:Among the 1 448 COVID-19 patients, 17(1.17%)were VTE positive, 60-69 years old patients were more common.The main clinical types were critical(64.7%) and severe(35.7%) types.The main clinical symptoms were lower extremity swelling(70.6%) and pain(35.7%);58.8% of the patients had a history of high risk factors related to VTE.Most VTE patients were peripheral(58.8%) and involved bilateral limbs(41.2%).The proportion of neutrophils, D-dimer and fibrin degradation products at the last examination were lower than those on admission to the hospital, while the total number and proportion of lymphocytes were higher.Of the17 VTE cases, 64.7% received venous catheterization, 58.8% received endotracheal intubation or tracheotomy, and 2 patients received extracorporeal membrane oxygenation(ECMO).The rate of bleeding was as high as 53%, and the risk of cardiovascular and cerebrovascular accidents was very high;the prognosis of the patients was poor, and the mortality rate was 23.5%.The cure rate was17.6%, and the improvement rate was 47.1%.Two patients were still in critically ill.Conclusion:Venous thromboembolism was common in elderly COVID-19 patients with severe types and critical types.Most patients were male and characterized by atypical symptoms, and the early active VTE risk assessment and prevention procedures should be adopted.The risk for bleeding and cardiovascular/cerebrovascular accidents was high, although most cases had good outcomes after active treatment.